In this month’s edition of Obstetric and Gynecological Survey, the authors of Home Versus Hospital Birth: Process and Outcome¹, make the following statement:
Women opting for home birth seek and often attain their goals of a nonmedicalized experience in comfortable, familiar surroundings wherein they maintain situational control.
I will agree that most women who choose home birth have the goal of a non-medicalized experience in comfortable, familiar surroundings. I don’t like the implication, however, that one goal of these women is maintaining situational control. If anything, women who birth at home seek an environment wherein they feel safe giving up control.
If anyone seeks to maintain situational control, it’s hospital personnel. For example:
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Hospitals and physicians prefer to plan the day and time of birth (cesarean delivery)
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Hospitals and physicians prefer to schedule labor (inductions)
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Hospitals and physicians prefer to artificially break the bag of waters (attempting to speed up the delivery)
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Hospitals and physicians prefer to administer epidural anesthesia to laboring women (controlling the speed of the labor and the sounds a woman makes)
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Hospitals and physicians prefer to routinely monitor all babies continuously, regardless of risk factors (attempt to guarantee perfect outcomes)
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Hospitals and physicians prefer to perform many newborn tests/vaccines prior to the newborn leaving the hospital, even if those tests are less accurate at such an early age and even if the vaccines are not truly needed at such a young age (attempt to control parent’s choice to have or not have procedures done)
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Hospitals and physicians prefer to speed up labors with Pitocin (attempt to control the length of labor)
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Hospitals and physicians prefer to set arbitrary limits for the length of time a woman can be in labor or pushing (controlling length of labor)
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Hospitals and physicians prefer to have IVs running for every woman (this limits the woman’s movement)
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Hospitals and physicians prefer to have women tethered to an electronic blood pressure cuff, external or internal monitors, and pulse oximeter (limits the woman’s movement)
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Hospitals and physicians prefer to tell a woman in what position she must give birth (controls the birth itself)
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Hospitals and physicians prefer to tell a woman when to push and when not to push (control of the birth itself)
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Hospitals and physicians prefer to remove a newborn infant from its mother’s arms until “it has a good cry, we get it cleaned up, we just check her over, we make sure she’s OK, we give him his eye drops and vitamin K, we get him weighed and measured, we check her blood sugar, we dry him off. . .” (control of the newborn infant and contact with mother)
In contrast, the women whom I have known and worked with, who have chosen home birth, opened their hearts to the unknown aspects of birth. They trusted their bodies to know how to do it when their heads didn’t. They waited, sometimes impatiently, for labor to begin in its own time. They worked long and hard with a labor that was difficult, to birth their babies. They accepted pain and discomfort as an important part of the process. They were willing to embrace a birth that didn’t go the way they’d hoped. They were willing to choose a road less traveled, weathering the skepticism and fears of family and friends, not because they set a goal of maintaining control, but because they set a goal of giving their births and their babies the best possible opportunity to unfold without unneeded interference.
The same might be said of the woman who, for any reason, chooses a hospital birth but creates a birth plan for herself. Hospital staff, rather than showing the typical scornful response (“Well, she’ll end out with a c-section for sure; what a control freak!”) might appreciate the woman’s efforts to choose the very best she can for her baby. It’s not about control. It’s about one in three mothers being cut open to deliver their babies. It’s about every woman who is told she can’t get out of bed, can’t eat or drink, can’t walk, can’t get in the jacuzzi, can’t, can’t, can’t. It’s about taking the fear out of birth and returning it to the calm transition to new life that it should be. It’s about finally letting birth happen normally, just as ever-accumulating evidence indicates it should.
1. Wax JR, Pinette MG, Cartin A. Home versus hospital birth: process and outcome. Obstetrical & Gynecological Survey: February 2010 – Volume 65 – Issue 2 – pp 132-140. Retrieved 2/9/10 from: http://journals.lww.com/obgynsurvey/Abstract/2010/02000/Home_Versus_Hospital_Birth_Process_and_Outcome.23.aspx
Having had 2 homebirths and 1 hospital birth – I definitely felt more comfortable giving up control at home than I did at the hospital. I’d say I was more of a control freak in the hospital than I was at home. I felt like if I just said “do whatever, whenever” to the numerous nurses/residents and on call OB’s that came in my room those 3 days – I probably would have had a c-section for no good medical reason (or medical reason had I accepted the many interventions they wanted to do)
With my homebirths, I knew that anything my midwife suggested – there was probably a good reason for it, and not a self-serving one.
You raise an excellent point–how important it is for us to be able to trust that our caregivers during labor truly believe in non-intervention and supporting normal birth.
You make an excellent point. I have told people myself that part of the reason I chose to have a home birth was that I felt I lacked control in a hospital setting. However, you’re right. When I was home, I was able to give up control in a way that would have resulted in me being taken advantage of in the hospital. I have seen couples in the hospital who are prepared to fight for control from the second they step onto the L&D unit, and that isn’t what its like in a home birth. A home birth allowed me to have the birth I wanted without having to fight for it.
Not having to “fight” for the births we want is so important. If you look at how mammals behave when disturbed or threatened during labor, their labor will slow down or even stop to allow them to move to a safe location for birth. This demonstrates how important it is for women to have a peaceful, stress-free environment for the best birth outcomes.
I’m with a midwife group at a hospital, but I specifically chose them because they have a 13% section rate, a 1% episiotomy rate, etc. I chose them because I feel I have *control* with them, and they emphasize that I do indeed control things. I question *anyone* who would go through such an important event and cede control to anyone else. (I would gladly have a home birth but certain circumstances would make it impossible.)
Now, am I a control freak in day to day life? Not at all. I much prefer other people to have control, I easily designate control to others, I “go with the flow.” I have no interest in being a leader.
(I’m not proud to say these things – in fact, typing them out is embarrassing.)
But I have half a brain to know that the choices we make before birth directly affect how that birth is going to play out in the vast majority of cases.
If the good authors of the piece meant “maintain situational control” as an insult, in my opinion, they failed miserably. It makes me feel GOOD to be told I am maintaining “situational control” and it makes me feel like I’m being the best parent I can be, right from the start.
Thank you for sharing another perspective on control! I agree with you, that it is important that we control our birth environment and what interventions take place, in order to preserve the normalcy of birth.
Great post!
I think the issue is the BALANCE of control. In fact, when I am done gathering information on certain practice patterns for labor and delivery in my area, I am going to see if attitudes and usage depend on the balance of autonomy between phsycian and patient. I strongly suspect it does. Let’s see what the data shows.
We look forward to the results of your research!
Actually, having met one myself, I’d have to say a loud and resounding, YES! Not only that, but selfish as well. For as many women that have had a ’successful’ homebirth, I’ve met just as many who’ve ended up with stillborns or major health complications themselves. Whatever happened to healthy mom AND baby being the desired end? If that means ‘intervention’ or ‘hospital assistance,’ so be it! This is not the place to play out our power trips. Save that for the olympics. This is about LIFE.
I find that hard to believe because when homebirths result in stillborn or major health complications, it’s usually in the news but when a hospital birth ends in a stillbirth or major health complication, it’s not. Given the number of states that do not support homebirths (it’s easier to find an abortionist then it is a midwife, so much for “Freedom of Choice”), the number of insurance providers that do not support homebirths and the Good Ole Boys network that tends to coverup when a hospital birth goes wrong, I’d love to know where you live that so many women have been able to homebirth that the ratio is one for one of homebirths. I live in a city of one million. Since 1998 there has only been one midwive assisted homebirth stillbirth, compared to hundreds of successful midwife assisted homebirths.
You make a very pertinent point. Why do reproductive rights not extend to childbirth? If I can make the decision at near-term to abort my baby (yes, there are still places offering this service), why can’t I make a decision to birth in a way that my doctor my believe is “dangerous”? At that point, it clearly boils down to two factors: fear of litigation, and belief that since the physician knows best, the woman who does not comply with his wishes does not care about her baby and is an unfit parent. I have seen too many court orders for removal of babies due to parents standing up for their rights. Unfortunately, in this country a woman has the right to refuse treatment but she may lose her baby because of it.
It isn’t so much about control, as being able to make (or be part of) decisions. As outlined in your post, “No” is the answer routinely given to women in a hospital who want to birth in a particular position, drink a glass of water, etc. While a midwife attending a homebirth may also give instructions, she will do so with the specific needs of the mother in mind rather than having a single treatment plan that is applied to every woman. If labor is proceeding normally and without intervention, there is no need for anyone to control anything.